From the Research
Pronator teres syndrome should be initially managed with conservative measures, including rest, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs), with surgical decompression considered if conservative treatment fails after 3-6 months, as supported by the most recent study 1. The condition is a compression neuropathy where the median nerve is entrapped as it passes through the pronator teres muscle in the forearm, causing pain, numbness, and tingling in the forearm, wrist, and hand. Initial treatment focuses on conservative measures including:
- Rest
- Activity modification to avoid aggravating movements like forceful pronation
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation Physical therapy is crucial, incorporating:
- Gentle stretching exercises for the pronator teres muscle
- Nerve gliding techniques
- Strengthening of surrounding muscles Night splinting of the wrist in a neutral position may help reduce symptoms. Corticosteroid injections around the pronator teres muscle can provide temporary relief for persistent cases. Surgical decompression may be necessary if conservative treatment fails, involving release of the pronator teres muscle to free the compressed median nerve, as shown in a case study 2. Recovery typically requires 6-12 weeks of rehabilitation. This condition differs from carpal tunnel syndrome by causing more proximal forearm pain and less nocturnal symptoms, though both affect the median nerve at different locations, as discussed in a review of the literature 1. It is essential for clinicians to have a thorough understanding of median nerve anatomy, possible sites of compression, and characteristic clinical findings of pronator teres syndrome to provide a reliable diagnosis and treat their patients, as emphasized in a study on proximal median nerve compression 3. The outcome of surgical treatment for isolated pronator teres syndromes has been shown to be satisfactory, with significant improvement in symptoms and functional outcome, as reported in a retrospective cohort study 1. However, the possibility of postoperative carpal tunnel syndrome should be considered, and a focus on double-crush syndrome in unclear or mixed symptoms is necessary to avoid multiple operations, as noted in the study 1.